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Hospitalization Report for PDL: John Doe

Three sentences: 1) This report provides details of a hospitalization of a prisoner named John Doe from Manila City Jail, including his personal information, charges, and admitting diagnosis. 2) It documents the date and time of hospitalization, the treating hospital and physician, and the circumstances that led to the hospitalization. 3) The report also includes a summary of the prisoner's prior medical history and treatments, as well as notes the actions taken and any attachments.

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Bhell Mendiola
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99 views1 page

Hospitalization Report for PDL: John Doe

Three sentences: 1) This report provides details of a hospitalization of a prisoner named John Doe from Manila City Jail, including his personal information, charges, and admitting diagnosis. 2) It documents the date and time of hospitalization, the treating hospital and physician, and the circumstances that led to the hospitalization. 3) The report also includes a summary of the prisoner's prior medical history and treatments, as well as notes the actions taken and any attachments.

Uploaded by

Bhell Mendiola
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

DHS FORM 02

Republic of the Philippines


DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
BUREAU OF JAIL MANAGEMENT AND PENOLOGY
NATIONAL HEADQUARTERS
144 Mindanao Avenue, Quezon City
Email Address: bjmphealthservice@gmail.com

HOSPITALIZATION REPORT OF PDL


Name of Reporting Facility Date and Time of Report Control No. Dorm
Manila City Jail March 21, 2019/0800H 2019-08-#01
Name of PDL Sex Age Civil Status
John Doe Male 31
Last Known Address
144 Mindanao Avenue, Quezon City
Offense/s Charges Criminal Case No. Court/Branch
Rape 1234-5678-890 RTC 23

Particulars
Date of Hospitalization Time of Hospitalization Name of Hospital

Address

Name of Attending
Physician

Admitting Diagnosis

Circumstances of Hospitalization

PDL Medical History


(Summary of previous ailments, hospitalization records)

Action Taken

List of Attachments (if any)

Prepared by: Noted by:


JO1 Maria Palanggana, RN SINSP MARIO MARIANO
Nurse on Duty Warden, Manila City Jail

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